The Journal of Prevention of Alzheimer's Disease最新文献

{"title":"Quantifying generalization error in machine learning prediction of cognitive decline.","authors":"Roya Melanie Hüppi, Nicolas Langer, Bruno Hebling Vieira","doi":"10.1016/j.tjpad.2026.100646","DOIUrl":"10.1016/j.tjpad.2026.100646","url":null,"abstract":"<p><strong>Background: </strong>Predicting cognitive decline as a continuum, from healthy age-related decline to mild cognitive impairment and dementia, enables more precise individual-level predictions. However, the practical value of such models for early intervention and prevention depends on their ability to generalize to independent cohorts, a property that is often not evaluated.</p><p><strong>Objectives: </strong>This study investigated whether adding structural magnetic resonance imaging (MRI) to non-brain data improved machine learning predictions of continuous cognitive decline and analyzed the models' generalizability.</p><p><strong>Design: </strong>Multi-target random forest regression models predicted annual decline in the Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) and Mini-Mental State Examination (MMSE) using non-brain data, structural MRI data, or their combination from the Alzheimer's Disease Neuroimaging Initiative (ADNI; N = 1237) and Open Access Series of Imaging Studies (OASIS-3; N = 662) datasets. Cross-site generalizability was evaluated.</p><p><strong>Setting: </strong>Data from ADNI and OASIS-3 were used for this study.</p><p><strong>Participants: </strong>A total of 1899 participants who had demographic, clinical, and brain imaging data from a baseline session and clinical data from at least 2 follow-up sessions were included.</p><p><strong>Measurements: </strong>Baseline non-brain (demographics, clinical and neuropsychological scores, information on APOE genotype, cognitive diagnosis, health, and number of sessions before baseline) and/or structural MRI data were used to predict the yearly rate of change in CDR-SOB and MMSE scores.</p><p><strong>Results: </strong>Including structural MRI data improved prediction of CDR-SOB and MMSE change, reaching respective R² values of .41 and .33 in ADNI and .42 and .33 in OASIS-3. Model performance for across-dataset predictions was reduced (R² between .18 and .35), unexplained by distributional shifts of target variables. Models using only top predictive features performed similarly to full models when tested externally (R² between .18 and .34), suggesting predictor redundancy.</p><p><strong>Conclusions: </strong>Incorporating structural MRI data enhances within-dataset prediction of continuous cognitive decline, allowing for more precise individual-level prediction and advancing towards precision medicine. Even though external validation remains limited, quantifying the generalizability gap is a crucial step towards the responsible use of ML models in clinical intervention and prevention.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 9","pages":"100646"},"PeriodicalIF":7.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating frailty into decision-making for disease-modifying therapies in Alzheimer's disease: a proposed expert-opinion based approach.","authors":"Giuseppe Bellelli, Ovidio Brignoli, Marco Canevelli, Antonio Cherubini, Andrew Clegg, Bruno Dubois, Maria Cristina Ferrara, Laura Fratiglioni, Giovanni B Frisoni, Giulia Grande, Frank Jessen, Sean P Kennelly, Alberto Magni, Martina Marelli, Alessandra Marengoni, Nicolás Martínez Velilla, Susan D Shenkin, Marc Suárez-Calvet, Suzanne Timmons, Alessandro Padovani","doi":"10.1016/j.tjpad.2026.100666","DOIUrl":"10.1016/j.tjpad.2026.100666","url":null,"abstract":"<p><p>The introduction of disease-modifying therapies for Alzheimer's disease (AD-DMTs) is reshaping clinical practice, raising critical questions about patient selection, diagnostic pathways, treatment appropriateness, and equity of access. Frailty, a multidimensional condition of reduced physiological reserve and increased vulnerability to stressors, is common in older adults with AD, yet has not been systematically assessed in AD-DMTs trials, limiting the generalizability of trial findings to real-world populations. In this review, we examine the role of frailty in the emerging era of AD-DMTs, summarizing evidence on its prevalence and prognostic relevance, approaches to its assessment, and its potential impact on treatment safety and effectiveness. We propose that regular frailty assessment should inform decision-making in both clinical trials and clinical practice, while frailty-informed management-including medication review and multidomain interventions-may support more appropriate, individualized care.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 9","pages":"100666"},"PeriodicalIF":7.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choroid plexus volume in pathology-confirmed Alzheimer's disease.","authors":"Francis Fernandes, Avyarthana Dey, Andy Ma, Nathan W Churchill, Corinne E Fischer, Simon J Graham, David G Munoz, Tom A Schweizer","doi":"10.1016/j.tjpad.2026.100648","DOIUrl":"10.1016/j.tjpad.2026.100648","url":null,"abstract":"<p><strong>Introduction: </strong>The choroid plexus (CP) increases in volume across the Alzheimer's disease (AD) continuum, suggesting its potential as a clearance-related biomarker. However, few studies have examined ante-mortem CP volume in relation to post-mortem AD pathology, the gold standard for diagnosis.</p><p><strong>Methods: </strong>Participants who had structural magnetic resonance imaging and post-mortem pathology, with an interval of ≤ 5 years between imaging and death, were examined. Normalized CP volume (NCPV) was semi-automatically segmented from the lateral ventricles and analyzed using Bayesian linear regression to estimate associations with cognitive impairment (CI), AD pathology, and relevant clinical/demographic data.</p><p><strong>Results: </strong>Intermediate and high levels of AD pathology and CI were associated with larger NCPV, whereas female sex was associated with lower NCPV. Subgroup analyses showed larger NCPV in individuals with greater CI despite comparable levels of AD pathology.</p><p><strong>Discussion: </strong>These findings link CP enlargement to neuropathologically confirmed AD burden and CI, supporting further investigation of CP structure and function in AD.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 9","pages":"100648"},"PeriodicalIF":7.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of cognitive decline onset and life-course trajectories A pooled longitudinal analysis of 14,389 adults across three cohorts.","authors":"Jan Sebastian Novotný, Sivan Klil-Drori, Yonas Endale Geda, Ziad Nasreddine, Gorazd Bernard Stokin","doi":"10.1016/j.tjpad.2026.100649","DOIUrl":"10.1016/j.tjpad.2026.100649","url":null,"abstract":"<p><strong>Background: </strong>Population ageing is driving a global surge in cognitive impairment. While late-life decline is well-characterized, the onset of measurable cognitive changes across the full adult lifespan remains uncertain. We aimed to estimate the age at which detectable decline begins using longitudinal data from three population-based cohorts from three countries spanning three continents.</p><p><strong>Methods: </strong>We analyzed participant-level longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS; China), Midlife in the United States (MIDUS; USA), and Kardiovize (KV; Czech Republic). Cognitive performance was assessed using validated instruments (TICS, BTACT, and MoCA). Scores were harmonized using the percent of maximum possible method (0-100 metric). Linear mixed-effects models, adjusted for age group, sex, and education estimated change over an average 7-9-year follow-up.</p><p><strong>Findings: </strong>In pooled sample of 14,389 participants (baseline age 22-94 years), a detectable decline in total cognition first emerged in the 31-40 age group (mean change -1.2 points, 95% CI -2.1 to -0.3). Decline magnitude increased progressively with age, reaching -11.4-points in the oldest strata (all p<0.001). Non-memory domains showed earlier vulnerability (detectable from age 31), while significant memory decline emerged after age 50. Individual trajectories showed substantial heterogeneity, suggesting that chronological age is not a deterministic proxy for decline.</p><p><strong>Interpretation: </strong>Population-level cognitive decline became detectable in early midlife, decades before the traditional clinical focus on older age. Across three population-based cohorts from Asia, North America, and Europe, we observed consistent early decline in non-memory domains followed by later memory decline. These findings support evaluation of midlife cognitive monitoring and life-course approaches to brain health.</p><p><strong>Funding: </strong>European Union Next Generation EU; European Regional Development Fund; European Social Fund; Barrow Neurological Foundation; NIH.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 9","pages":"100649"},"PeriodicalIF":7.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Prevalence and Care Needs of Dementia in Adults Aged >=55 Years: Findings from the China Mental Health Survey.","authors":"Zhaorui Liu, Guangming Xu, Ruoxi Ding, Chao Ma, Yueqin Huang, Lingjiang Li, Tingting Zhang, Jie Yan, Yaqin Yu, Xiufeng Xu, Zhizhong Wang, Yifeng Xu, Tao Li, Huifang Yin, Xiangdong Xu, Limin Wang, Yongping Yan, Shuiyuan Xiao","doi":"10.1016/j.tjpad.2026.100659","DOIUrl":"10.1016/j.tjpad.2026.100659","url":null,"abstract":"<p><strong>Background: </strong>Dementia is a major global mortality cause and key driver of disability in older adults, imposing multidimensional burdens. As China's population ages, accurate prevalence estimates and care need assessments are essential for equitable policy planning. This study investigates young- and late-onset dementia prevalence while comparing health service utilization and unmet care needs between affected and unaffected populations.</p><p><strong>Methods: </strong>Utilizing China Mental Health Survey data (2013-2015) with multistage probability sampling, we identified 12,663 nationally representative adults aged ≥55 years. Of these, 10,839 completed Stage I assessments and 2,261 received Stage II evaluations, supplemented by psychiatric assessments of initial non-participants (n=197). Dementia diagnosis followed DSM-IV criteria via validated cognitive/functional instruments. Health service utilization and multidimensional care needs (ADLs/IADLs/safety) were quantified through participant/informant interviews.</p><p><strong>Results: </strong>Among 2 458 participants assessed, dementia prevalence was 2.65% (55-64y) and 5.56% (≥65y). Rural residents showed consistently higher rates than urban counterparts across age groups. Significant education gradients emerged, with urban prevalence decreasing with higher education while rural patterns differed. Individual living with dementia required substantially more care for both samples (55-64 years: 37.4% vs 11..9%, +81.3 monthly hours; 65+ years: 62.6% vs 13.4%, +88.8 monthly hours) without increased health service utilization.</p><p><strong>Conclusion: </strong>This national study reveals substantial dementia burden in China, exposing systemic healthcare deficiencies through misaligned functional care needs and medical engagement. The neglect of chronic disability management in aging populations necessitates urgent integration of prevention strategies and tailored support frameworks within primary care systems.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 9","pages":"100659"},"PeriodicalIF":7.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral microhemorrhage and cognition in preclinical Alzheimer's disease.","authors":"Dobri Baldaranov, Shunran Wang, Rema Raman, Karin Ernstrom, Kejal Kantarci, Clifford R Jack, Reisa A Sperling, Paul S Aisen, Michael S Rafii","doi":"10.1016/j.tjpad.2026.100681","DOIUrl":"https://doi.org/10.1016/j.tjpad.2026.100681","url":null,"abstract":"<p><strong>Background: </strong>Clarifying whether incident cerebral microhemorrhages (CMHs) contribute to early cognitive or functional decline is increasingly important in the context of anti-amyloid therapies.</p><p><strong>Objective: </strong>To determine whether incident CMHs are associated with longitudinal changes in cognition and function in cognitively unimpaired individuals with elevated cerebral amyloid.</p><p><strong>Design, setting, and participants: </strong>Post hoc analysis of individuals enrolled in the A4 study. Participants underwent serial MRI and cognitive assessments. Natural cubic spline models adjusted for baseline amyloid PET burden, age, sex, education, and APOE ε4 status.</p><p><strong>Measurements: </strong>Longitudinal change in the Preclinical Alzheimer Cognitive Composite (PACC), Clinical Dementia Rating-Sum of Boxes (CDR-SB), Cognitive Function Index (CFI), and Activities of Daily Living.</p><p><strong>Results: </strong>Participants who developed ≥2 incident CMHs demonstrated greater longitudinal worsening in CDR-SB (estimate = 0.44; 95% CI, 0.09-0.80; P = .009) and CFI (estimate = 1.37; 95% CI, 0.11-2.60; P = .03), but not in PACC or ADCS ADL.</p><p><strong>Conclusions: </strong>Incident CMH accumulation was associated with greater longitudinal worsening in global clinical status and participant-reported functional change, but not objective cognitive performance, among cognitively unimpaired individuals with elevated cerebral amyloid.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 10","pages":"100681"},"PeriodicalIF":7.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline MRI markers and clinical outcomes during anti-amyloid β therapy: A real-world study in a Japanese dementia center.","authors":"Yuki Kujuro, Marina Saito, Manami Maruko, Kazuko Kamiyama, Aya Nakano, Emi Qian, Teppei Okamura, Daisuke Ito, Toshimi Kageyama, Ichiro Sugiyama, Eriko Ishihara, Tatsuro Kuwahara, Kazunori Moritani, Hitoshi Katai, Hidenori Hattori","doi":"10.1016/j.tjpad.2026.100686","DOIUrl":"https://doi.org/10.1016/j.tjpad.2026.100686","url":null,"abstract":"<p><strong>Importance: </strong>Predictors of decline and of amyloid-related imaging abnormalities (ARIA) during anti-amyloid β therapy in routine care are undefined.</p><p><strong>Objective: </strong>To identify baseline predictors of cognitive, functional, and safety outcomes.</p><p><strong>Design, setting, and participants: </strong>Retrospective cohort of 161 consecutive patients initiating anti-amyloid β therapy at a Tokyo dementia center, 2024 to 2026 (lecanemab, 89; donanemab, 72).</p><p><strong>Exposures: </strong>Lecanemab or donanemab.</p><p><strong>Main outcomes and measures: </strong>Change in MMSE and CDR-Sum of Boxes (CDR-SB); baseline medial temporal atrophy (VSRAD Z score), amyloid PET burden, and microbleeds; ARIA.</p><p><strong>Results: </strong>With lecanemab, MMSE and CDR-SB declined significantly at every assessment (CDR-SB +0.79, +1.10, +1.60 at 6, 12, 18 months); memory and orientation declined while language was preserved. Greater baseline medial temporal atrophy was associated with greater 12-month CDR-SB worsening (r = 0.39; P = .01; n = 40); patients in the most severe standard category (Z ≥ 3) worsened by 2.62 versus 0.64 points (adjusted β = +2.18; P < .001). Atrophy was associated with older age (r = 0.19; P = .03) and with baseline memory-related measures - ADAS-Cog score (r = 0.32; P < .001) and the MMSE subdomains of delayed recall (β = -0.25; P = .006) and time orientation (β = -0.30; P = .04) - but not MMSE total score. Amyloid PET burden showed no significant association at most time points. All ARIA events were asymptomatic; ARIA-H occurred in 6 of 25 with microbleeds versus 3 of 136 without (odds ratio, 14.0; P < .001). Donanemab follow-up was 6 months.</p><p><strong>Conclusions and relevance: </strong>Baseline medial temporal atrophy was associated with functional decline and microbleeds with ARIA-H. Pretreatment MRI may provide prognostic and safety information during anti-amyloid β therapy.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 10","pages":"100686"},"PeriodicalIF":7.8,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated Italian intersocietal recommendations for the appropriate use of anti-amyloid monoclonal antibodies in Alzheimer's disease.","authors":"Alberto Benussi, Federica Agosta, Luisa Agnello, Alba Rosa Alfano, Mattia Altini, Antonio Antico, Stefania Basilico, Giuseppe Bellelli, Laura Bonanni, Gabriella Bottini, Marco Bozzali, Ovidio Brignoli, Giuseppe Bruno, Annachiara Cagnin, Sonia Francesca Calloni, Stefano F Cappa, Filippo Caraci, Diego Cecchin, Marcello Ciaccio, Sirio Cocozza, Mirco Cosottini, Diego De Leo, Andrea Falini, Lorenzo Gaetani, Nicoletta Gandolfo, Fabio Gotta, Raffaele Lodi, Giancarlo Logroscino, Elena Marcello, Camillo Marra, Walter Marrocco, Silvia Morbelli, Patrizia Mecocci, Enrico Mossello, Lorenzo Palleschi, Pasquale Palumbo, Leonardo Pantoni, Lucilla Parnetti, Luca Roccatagliata, Sandro Sorbi, Patrizia Spadin, Alessandra Splendiani, Alessandro Tessitore, Andrea Ungar, Giuseppe Zappalà, Alessandro Padovani","doi":"10.1016/j.tjpad.2026.100685","DOIUrl":"10.1016/j.tjpad.2026.100685","url":null,"abstract":"<p><p>With the European authorisation of lecanemab and donanemab, Italy is entering the era of disease-modifying therapy for early symptomatic Alzheimer's disease. The Italian Expert Panel on Alzheimer (EPA), which convened 21 scientific societies and patient associations and published a first set of intersocietal recommendations in 2025, was reconvened in Rome on 24 January 2026 (EPA2) to address the operational gaps that had emerged during the implementation of that document. A modified Delphi process was adopted to formalise consensus on the most controversial points raised during the meeting. Thirty-six declarative statements covering five domains, namely the tiered organisation of the Centres for Cognitive Disorders and Dementia (CDCD), clinical staging and treatment monitoring, eligibility considerations in mild cognitive impairment and atypical phenotypes, composition of the multidisciplinary team, and magnetic resonance imaging thresholds, ARIA monitoring and biomarker pathway, were submitted to a multidisciplinary panel of experts. Strong agreement was reached on the large majority of statements, providing quantitative endorsement for a competence-based reorganisation of the CDCD network, the harmonised use of the Clinical Dementia Rating, an explicit composition of the multidisciplinary team, trial-aligned magnetic resonance imaging eligibility criteria with a move towards risk-adapted ARIA monitoring, and a stepwise biomarker pathway integrating plasma assays, cerebrospinal fluid analysis on automated platforms and amyloid positron emission tomography. The document provides Italian regional and national health systems, prescribing centres and reimbursing authorities with a quantitative blueprint for the appropriate, equitable and sustainable use of anti-amyloid monoclonal antibodies in clinical practice.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 10","pages":"100685"},"PeriodicalIF":7.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the eligible population for amyloid-targeting monoclonal antibody therapy in memory clinics: Application to lecanemab in France.","authors":"Lisa Le Scouarnec, Vincent Bouteloup, Leslie Grasset, Vincent Planche, Geneviève Chêne, Carole Dufouil","doi":"10.1016/j.tjpad.2026.100683","DOIUrl":"10.1016/j.tjpad.2026.100683","url":null,"abstract":"<p><p>Lecanemab was the first amyloid-targeting monoclonal antibody approved by the European Commission for treating patients with mild cognitive impairment (MCI) and mild dementia due to Alzheimer's disease (AD). While this marketing authorization led to heterogeneous situations across European countries, France declined reimbursement, citing limited clinical benefit and concerns about the healthcare system's capacity to implement this new care pathway. This capacity depends directly on the number of eligible patients, yet robust estimates remain limited and highly variable across studies. Our objective was therefore to estimate the population eligible for lecanemab in France. Using transportability methods based on inverse odds of selection weighting, we articulated the nationwide consultation data from the French National Alzheimer Database (BNA) with the deeply phenotyped MEMENTO clinical cohort. Eligibility for lecanemab followed the French appropriate use recommendations: 1) clinical eligibility (age 50-90 years, MCI with common AD phenotype or mild AD dementia, MMSE ≥22), 2) biological eligibility (amyloid confirmation determined sequentially using plasma p-tau217, cerebrospinal fluid biomarkers and amyloid-PET), 3) absence of contraindications (APOEε4 homozygosity, anticoagulant use, MRI risk markers for ARIA). Among patients consulting French memory clinics, 19.5% met clinical eligibility criteria. Of these, 73.0% (95%CI: 67.6-77.9) were amyloid-positive, and 49.7% (95%CI: 44.0-55.5) remained eligible after applying safety criteria. Overall, 9.7% (95%CI: 8.6-10.8) of patients consulting memory clinics were estimated to be eligible for lecanemab, representing approximately 18,200 individuals nationally (annual average, 2022-2024). These results inform healthcare planning for disease-modifying therapy implementation in France and comparable countries.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 10","pages":"100683"},"PeriodicalIF":7.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological interventions for reducing the risk of cognitive decline and dementia after stroke/transient ischemic attack: A systematic review.","authors":"Colin Rosenau, Lieke Bakker, Veerle van Gils, Sebastian Köhler, Kay Deckers","doi":"10.1016/j.tjpad.2026.100680","DOIUrl":"10.1016/j.tjpad.2026.100680","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a leading cause of death and disability worldwide. Advances in stroke care have improved survival and recovery, but it remains unclear whether pharmacological treatments can prevent long-term consequences including cognitive decline and dementia. This systematic review examined whether pharmacological interventions reduce the risk of cognitive decline, mild cognitive impairment (MCI), or dementia in adults with a history of stroke or symptomatic transient ischemic attack (TIA).</p><p><strong>Methods: </strong>We searched Medline, EMBASE, PsychINFO, and Cochrane Central from inception to January 23, 2025, for systematic reviews and meta-analyses of randomized controlled trials (RCTs). Eligible studies included adults with prior stroke or symptomatic TIA receiving pharmacological interventions, blood pressure-lowering, antithrombotic, and lipid-lowering drugs, compared with placebo, no treatment, or usual care. Primary outcomes were incident dementia, MCI, and cognitive decline assessed at least three months post-event. Methodological quality was assessed with AMSTAR 2, and certainty of evidence using GRADE. The protocol was registered in PROSPERO (CRD420251000825).</p><p><strong>Results: </strong>Of 1343 records screened, 8 systematic reviews met inclusion criteria. The most comprehensive systematic review, including all relevant RCTs, was selected for detailed data extraction. Certainty of evidence was mostly low, with a few exceptions of moderate to high certainty. Across drug classes and outcomes, pharmacological interventions generally showed no meaningful reductions in dementia, MCI, and cognitive decline over a mean follow-up of 2.0-4.9 years.</p><p><strong>Conclusions: </strong>Current evidence does not support pharmacological interventions after a cerebrovascular event for reducing risk of cognitive decline, MCI, or dementia. Further high-quality studies with longer follow-ups are needed.</p>","PeriodicalId":22711,"journal":{"name":"The Journal of Prevention of Alzheimer's Disease","volume":"13 10","pages":"100680"},"PeriodicalIF":7.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}